Cost-effectiveness of selective serotonin reuptake inhibitors and routine specialist care with and without cognitive behavioural therapy in adolescents with major depression.

BACKGROUND: Major depression is an important and costly problem among adolescents, yet evidence to support the provision of cost-effective treatments is lacking. AIMS: To assess the short-term cost-effectiveness of combined selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioural therapy (CBT) together with clinical care compared with SSRIs and clinical care alone in adolescents with major depression. METHOD: Pragmatic randomised controlled trial in the UK. Outcomes and costs were assessed at baseline, 12 and 28 weeks. RESULTS: The trial comprised 208 adolescents, aged 11-17 years, with major or probable major depression who had not responded to a brief initial psychosocial intervention. There were no significant differences in outcome between the groups with and without CBT. Costs were higher in the group with CBT, although not significantly so (P=0.057). Cost-effectiveness analysis and exploration of the associated uncertainty suggest there is less than a 30% probability that CBT plus SSRIs is more cost-effective than SSRIs alone. CONCLUSIONS: A combination of CBT plus SSRIs is not more cost-effective in the short-term than SSRIs alone for treating adolescents with major depression in receipt of routine specialist clinical care.

Latent negative self-schema and high emotionality in well adolescents at risk for psychopathology.

Teasdale's (1988) differential activation hypothesis proposes that a tendency for negative mood to activate latent negative self-schemas characterises people at risk for depression. The current study tested predictions from this hypothesis in a community sample of 102 adolescents who were free from history of psychiatric illness, and who were subdivided according to level of emotionality, a temperamental style as assessed by parental questionnaire. A musical mood induction task was used to induce temporary mild dysphoria, and the effect of mood induction on self-schemas was assessed. There was no difference between high and low emotionality groups in the liability to sad mood induction. However, adolescents with high emotionality endorsed significantly more negative self-descriptors after dysphoric, but not after neutral, mood induction. This was not accounted for by level of self-reported depressive symptoms over the previous week. This suggests that a " dysphoric mood induction challenge" may provide important information about vulnerability to depression that is not identified by routine self-report of mood or cognitions.

Temperament and psychopathology amongst siblings of probands with depressive and anxiety disorders.

Thirteen (42%) of 31 siblings of 29 probands with depression (n = 21) or anxiety disorders (n = 8) attending a clinic met DSM-IIIR criteria for psychiatric disorder, a rate nearly three times greater than reported from community studies. The diagnoses were heterogeneous. Compared with probands, sibling cases had half the level of comorbidity and significantly lower levels of psychosocial impairment. Comparisons of temperamental characteristics showed that higher levels of emotionality, but no other aspect of temperament, was associated with an increased likelihood of a sibling being a case. Higher emotionally in all cases (sibs and probands) was associated with greater comorbidity in general and the diagnoses of dysthymia and separation anxiety in particular.